Exertional Heat Stroke and Rhabdomyolysis: A Medical Record Review and Patient Perspective on Management and Long-Term Symptoms
Abstract Introduction Exertional heat stroke (EHS) is a medical emergency, occurring when the body generates more heat than it can dissipate, and frequently associated with exertional rhabdomyolysis (ERM). In the present study we aimed to (I) identify clinical features and risk factors, (II) describ...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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SpringerOpen
2023-05-01
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| Series: | Sports Medicine - Open |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s40798-023-00570-y |
| _version_ | 1797822839387062272 |
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| author | Nick Kruijt L. R. van den Bersselaar M. T. E. Hopman M. M. J. Snoeck M. van Rijswick T. G. H. Wiggers H. Jungbluth C. C. W. G. Bongers N. C. Voermans |
| author_facet | Nick Kruijt L. R. van den Bersselaar M. T. E. Hopman M. M. J. Snoeck M. van Rijswick T. G. H. Wiggers H. Jungbluth C. C. W. G. Bongers N. C. Voermans |
| author_sort | Nick Kruijt |
| collection | DOAJ |
| description | Abstract Introduction Exertional heat stroke (EHS) is a medical emergency, occurring when the body generates more heat than it can dissipate, and frequently associated with exertional rhabdomyolysis (ERM). In the present study we aimed to (I) identify clinical features and risk factors, (II) describe current prehospital management, (III) investigate long-term outcomes including the impact on mental health, and review the guidance received during restarting activities. We hope that our approach will improve individual and organizational heat illness preparedness, and improve follow-up care. Methods We performed a prospective online survey and retrospective medical record review among athletes and military personnel with an episode of EHS/ERM in the Netherlands between 2010 and 2020. We evaluated prehospital management, risk factors, clinical features and long-term outcomes at 6 and 12 months after the event, including mental health symptoms. Furthermore, we investigated what guidance participants received during follow-up, and assessed the patients’ perspective on these outcomes. Results Sixty participants were included, 42 male (70%) and 18 female (30%), of which 47 presented with EHS (78%) and 13 with ERM (22%). Prehospital management was inconsistent and in the majority of participants not conducted according to available guidelines. Self-reported risk factors included not feeling well-acclimatized to environmental heat (55%) and peer pressure (28%). Self-reported long-term symptoms included muscle symptoms at rest (26%) or during exercise (28%), and neurological sequelae (11%). Validated questionnaires (CIS, HADS and SF-36) were indicative of severe fatigue (30%) or mood/anxiety disorders (11%). Moreover, 90% expressed a lack of follow-up care and that a more frequent and intensive follow-up would have been beneficial for their recovery process. Conclusion Our findings indicate major inconsistencies in the management of patients with EHS/ERM, emphasizing the compelling need for implementing standardized protocols. Based on the results of long-term outcome measures, we recommend to counsel and evaluate every patient not only immediately after the event, but also in the long-term. |
| first_indexed | 2024-03-13T10:15:08Z |
| format | Article |
| id | doaj.art-d5c8d3ac818141f190d970a8f4063379 |
| institution | Directory Open Access Journal |
| issn | 2198-9761 |
| language | English |
| last_indexed | 2024-03-13T10:15:08Z |
| publishDate | 2023-05-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Sports Medicine - Open |
| spelling | doaj.art-d5c8d3ac818141f190d970a8f40633792023-05-21T11:17:18ZengSpringerOpenSports Medicine - Open2198-97612023-05-019111710.1186/s40798-023-00570-yExertional Heat Stroke and Rhabdomyolysis: A Medical Record Review and Patient Perspective on Management and Long-Term SymptomsNick Kruijt0L. R. van den Bersselaar1M. T. E. Hopman2M. M. J. Snoeck3M. van Rijswick4T. G. H. Wiggers5H. Jungbluth6C. C. W. G. Bongers7N. C. Voermans8Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical CentreDepartment of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical CentreDepartment of Physiology, RadboudumcMalignant Hyperthermia Investigation Unit, Department of Anesthesiology, Canisius Wilhelmina HospitalDepartment of Exercise Medicine and Exercise Physiology, Royal Dutch ArmyDepartment of Sports Medicine, Anna HospitalRandall Centre for Cell and Molecular Biophysics, Muscle Signalling Section, Faculty of Life Sciences and Medicine (FoLSM), King’s College LondonDepartment of Physiology, RadboudumcDepartment of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical CentreAbstract Introduction Exertional heat stroke (EHS) is a medical emergency, occurring when the body generates more heat than it can dissipate, and frequently associated with exertional rhabdomyolysis (ERM). In the present study we aimed to (I) identify clinical features and risk factors, (II) describe current prehospital management, (III) investigate long-term outcomes including the impact on mental health, and review the guidance received during restarting activities. We hope that our approach will improve individual and organizational heat illness preparedness, and improve follow-up care. Methods We performed a prospective online survey and retrospective medical record review among athletes and military personnel with an episode of EHS/ERM in the Netherlands between 2010 and 2020. We evaluated prehospital management, risk factors, clinical features and long-term outcomes at 6 and 12 months after the event, including mental health symptoms. Furthermore, we investigated what guidance participants received during follow-up, and assessed the patients’ perspective on these outcomes. Results Sixty participants were included, 42 male (70%) and 18 female (30%), of which 47 presented with EHS (78%) and 13 with ERM (22%). Prehospital management was inconsistent and in the majority of participants not conducted according to available guidelines. Self-reported risk factors included not feeling well-acclimatized to environmental heat (55%) and peer pressure (28%). Self-reported long-term symptoms included muscle symptoms at rest (26%) or during exercise (28%), and neurological sequelae (11%). Validated questionnaires (CIS, HADS and SF-36) were indicative of severe fatigue (30%) or mood/anxiety disorders (11%). Moreover, 90% expressed a lack of follow-up care and that a more frequent and intensive follow-up would have been beneficial for their recovery process. Conclusion Our findings indicate major inconsistencies in the management of patients with EHS/ERM, emphasizing the compelling need for implementing standardized protocols. Based on the results of long-term outcome measures, we recommend to counsel and evaluate every patient not only immediately after the event, but also in the long-term.https://doi.org/10.1186/s40798-023-00570-yHeat-related illnessesThermoregulationExercisePhysical activityMilitary personnelAthletes |
| spellingShingle | Nick Kruijt L. R. van den Bersselaar M. T. E. Hopman M. M. J. Snoeck M. van Rijswick T. G. H. Wiggers H. Jungbluth C. C. W. G. Bongers N. C. Voermans Exertional Heat Stroke and Rhabdomyolysis: A Medical Record Review and Patient Perspective on Management and Long-Term Symptoms Sports Medicine - Open Heat-related illnesses Thermoregulation Exercise Physical activity Military personnel Athletes |
| title | Exertional Heat Stroke and Rhabdomyolysis: A Medical Record Review and Patient Perspective on Management and Long-Term Symptoms |
| title_full | Exertional Heat Stroke and Rhabdomyolysis: A Medical Record Review and Patient Perspective on Management and Long-Term Symptoms |
| title_fullStr | Exertional Heat Stroke and Rhabdomyolysis: A Medical Record Review and Patient Perspective on Management and Long-Term Symptoms |
| title_full_unstemmed | Exertional Heat Stroke and Rhabdomyolysis: A Medical Record Review and Patient Perspective on Management and Long-Term Symptoms |
| title_short | Exertional Heat Stroke and Rhabdomyolysis: A Medical Record Review and Patient Perspective on Management and Long-Term Symptoms |
| title_sort | exertional heat stroke and rhabdomyolysis a medical record review and patient perspective on management and long term symptoms |
| topic | Heat-related illnesses Thermoregulation Exercise Physical activity Military personnel Athletes |
| url | https://doi.org/10.1186/s40798-023-00570-y |
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